Thursday, January 11, 2007

Good TV for Managers: Robinson at the NHS

I’m not a big TV watcher. Some nights the TV doesn’t go on in our house at all. However for the last three nights I’ve been gripped by a short series on BBC 2 called “Can Gerry Robinson Fix The NHS?

In this program Gerry Robinson (who you might describe as a celebrity business man, guru, turn-around specialist or something similar) spent six months helping an NHS hospital. His goal was apply some business management ideas to improve the hospital. Perhaps surprisingly it made for gripping TV and was highly education. (Note to aspiring managers: don’t bother doing an MBA, beg, borrow, steal copies of this series.)

What made it so fascinating? Well many things, basically you have management on one side who are trying to, well, manage, and you have a bunch of technical specialist on the other side (doctors, nurses, etc.) and there is a great divide between the two groups. Add in a history of top-down solutions which means nobody feels empowered and you have a recipe for Do Nothing.

More than once I found myself watching thinking: this is just like IT. The medical staff are just like programmers/testers/project managers and the management are just like, well, managers.

Robinson wasn’t given any money to improve the hospital – although he did manage to get some additional money spent. Instead his tools were those of inquiry, empowerment and using his legitimacy to get people to talk to each other.

Time and time again he found people who knew how to improve something but felt nothing could be done. They felt somebody would block any change or that nobody was interested in changing. And even if they did want to change things they could not get the right people to talk together or agree to actual action. About the half way mark this seemed to get Robinson really down.

But then it turned around and things started moving. People started to feel empowered, they started to feel things could change and they did start to change them. And consequently Robinson got much happier!

Of course its difficult to tell how much this chorology actually happened and how much was constructed through judicious editing to make a good story. Either way it certainly seems that people started to feel they could change things and this led to improvements.

I found myself agreeing again and again with Robinson when he said things like “Management isn’t a mystery” and “People doing the work know the answers”. It is all about getting the people who work to actually take power and make things happen. Unfortunately management can become a block to change rather than a catalyst.

There are so many barriers to change. The first barriers are in peoples own minds. They think things can’t be changed, or others won’t agree to them. Several times in the TV series people said “Mr X won’t agree to that” only to find that Mr. X and everyone else did agree.

The next barriers are the problems other people see. They jump to assumptions and see reasons why things won’t work or why you can’t do that. Sometimes there are real reasons and sometimes imagined. Either way these blocks can kill an idea dead. When they are imagined it is a case of checking reality, maybe by asking someone else. When the problem is real it is a trigger to work around the problem, to find an alternative answer or a different way of working.

Barriers of communication existed too. People didn’t talk to each other; they assumed what they thought to be the case was. Managers didn’t talk about problems, they preferred “strategic solutions” (shuffling paper, making plans and changing structures.) Technical people sometimes wanted to do their technical thing rather than engage in conversation and tended to see anything management did as a problem.

There never seemed to be a barrier with authority, only assumed authority. Neither were resources ever a real barriers. Once or twice lots of money or construction was needed so ideas were dropped but usually that was just led to a new idea that achieved much the same success.

In most cases all that was needed was someone to show an interest, someone to lend legitimacy to the improvement ideas, someone to ask for it to be done, someone to inject a sense of urgency and occasionally someone to bang heads together and get people talking to each other. And most of all: someone to appreciate what people had done, someone to say “Thank you.”

Robinson wondered around the hospital spotting opportunities and applying this (his) philosophy to the situation. It wasn’t genius but it got results. The rest of the time he seemed to spend his time trying to persuade the hospital chief executive to do the same thing. This guy was a “big thinker” who wanted “strategic plans” (my terms not his, this is the way he appeared to me.) As a result he was out of touch with what was happening. Staff felt he was remote and nobody (except Robinson) was walking around making people feel useful and conferring legitimacy to change.

I think Robinson’s greatest success was finally persuading the chief executive to try this approach. At first the exec was sceptical (“Why do they need me?”) but once he had one win under his belt the exec was converted and saw the point and was converted. His real power lay not in making plans, re-organizing structures or signing checks but in simply asking people to do what they wanted to do.

At the end of the day it wasn’t a big plan that was required, it wasn’t a new strategy, nor was it more money and resources. It was simply a thousand little improvements and a constant attention to further improvement.

As I said at the top, a very good programme. If there was more TV like this I’d watch TV more often. I’d love to buy the DVD of this series – if anyone out there knows where I can get it let me know.